Logan Steele
Chest pain is a common symptom of gastroesophageal reflux disease (GERD), which affects about 20% of adults and 10% of children in the U.S. GERD is characterised by chronic acid reflux, where stomach acid flows back into the oesophagus, causing a burning sensation and tissue damage. This can trigger esophageal spasms and pain in the upper chest, which may be felt as a sharp, tender, or burning sensation. While GERD-related chest pain is typically non-cardiac, it can be challenging to distinguish from cardiac chest pain, especially when it occurs concurrently with heartburn. Therefore, it is crucial to seek medical attention for chest pain to determine its underlying cause and receive appropriate treatment.
| Characteristics | Values |
|---|---|
| Cause | When gastric acid escapes from the stomach and backwashes into the esophagus, it burns the tissues on the inside, causing pain. |
| Location | GERD chest pain is usually felt behind the breastbone or sternum, in an area known as the epigastrium. |
| Intensity | GERD chest pain tends to be intense and may feel like stabbing or burning sensations just beneath the skin's surface. |
| Duration | GERD-related chest pain may last from a few seconds to a few hours. |
| Triggers | GERD chest pain can be triggered by deep breathing, coughing, or lying down. |
| Relief | GERD-related chest pain may improve when changing body position or sitting/standing up straight. |
| Treatment | Common treatments include proton pump inhibitors, esophageal motility treatments, pain modulators, and psychological therapies. |
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What You'll Learn
GERD is a common cause of noncardiac chest pain
While chest pain is a common symptom of a heart attack, it can also be caused by other conditions, such as gastroesophageal reflux disease (GERD). GERD is a common cause of noncardiac chest pain, which is chronic pain that feels like angina but is not heart-related.
GERD, or gastroesophageal reflux disease, is a condition where stomach acid frequently flows back into the oesophagus, causing a burning sensation and tissue damage. This backflow of acid can irritate and damage the oesophagus, leading to symptoms such as heartburn, which is characterised as a burning pain in the chest, close to the sternum or just beneath it. This pain can be intense and may feel like a stabbing or burning sensation just beneath the skin's surface. It is often accompanied by a burning sensation behind the breastbone and may not be felt as strongly in the left arm.
The pain associated with GERD can be differentiated from cardiac chest pain in several ways. Firstly, GERD pain tends to be more central, while cardiac pain typically starts in the left side of the chest. Secondly, GERD pain may change in intensity or disappear when changing body positions, such as straightening to a sitting or standing position. Bending and lying down may worsen GERD-related chest pain. In contrast, cardiac chest pain persists regardless of body position. Additionally, cardiac chest pain may worsen with movement and deep breathing, while GERD-related pain typically does not.
It is important to note that chest pain should always be taken seriously, and medical attention should be sought if there is any concern. While this information can help distinguish between cardiac and noncardiac chest pain, it is not a substitute for professional medical advice, diagnosis, or treatment.
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Acid reflux and esophageal spasms
Although heart-related chest pain and non-cardiac chest pain can be hard to distinguish, it is important to take any type of chest pain seriously. Non-cardiac chest pain is a chronic condition that feels like heart-related chest pain (angina) but is not related to the heart. GERD (chronic acid reflux) is the most common cause of non-cardiac chest pain.
Esophageal spasms are a rare condition that can be caused by acid reflux. They are unexpected, uncoordinated contractions of the esophageal muscles, which can cause pain in the throat and upper chest. This pain can feel sharp and tender, and may be accompanied by a burning sensation behind the breastbone. Esophageal spasms are not typically dangerous, but they can be very uncomfortable and may cause dysphagia or regurgitation of food. They can also be mistaken for a heart attack, so it is important to seek medical attention if you are experiencing chest pain.
Esophageal spasms can be diagnosed through X-rays, specifically with a barium swallow, which uses a specially prepared liquid to make the actions of the esophagus more visible. If external imaging is insufficient for a diagnosis, a more direct examination of the esophagus with images from an endoscope may be performed. Other tests, such as esophageal manometry, can gauge the function of the lower esophageal sphincter while swallowing water. Ph monitoring can also help identify the presence and severity of acid reflux contributing to the spasms.
Treatment options for esophageal spasms depend on the cause and severity. Nitroglycerin given under the tongue may help with sudden episodes, and long-acting nitroglycerin and calcium channel blockers are also used. Long-term cases may be treated with low-dose antidepressants or botulinum toxin injections into the esophagus. In rare cases, dilation of the esophagus or surgery may be necessary. Avoiding very hot or cold foods and certain trigger foods can also help manage esophageal spasms.
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Distinguishing between cardiac and noncardiac chest pain
Chest pain is a common reason for hospital visits, and it is important to take it seriously and seek medical attention. While it can be hard to distinguish between cardiac and noncardiac chest pain, there are some key differences to note.
Noncardiac chest pain (NCCP) is a chronic condition that feels like heart-related chest pain (angina) but is not related to the heart. It is a prevalent disorder that affects a person's quality of life, resulting in high healthcare utilization and significant work absenteeism. NCCP is often related to the oesophagus, which lies close to the heart in the chest cavity. GERD (gastroesophageal reflux disease) is the most common cause of NCCP, and it occurs when gastric acid escapes from the stomach and backwashes into the oesophagus, causing a burning sensation. Other causes of NCCP include oesophageal dysmotility, oesophageal hypersensitivity, and psychological comorbidities such as panic disorder, anxiety, and depression.
Cardiac chest pain, on the other hand, is typically associated with heart disease or a heart attack. The pain associated with heart disease can feel tight, squeezing, and crushing, and it may radiate down the left arm or into the jaw. It is important to seek emergency care if you are experiencing chest pain that is new and severe or accompanied by other symptoms such as shortness of breath, nausea, or feelings of indigestion.
To distinguish between cardiac and noncardiac chest pain, healthcare providers will perform a thorough evaluation to rule out any acute life-threatening cardiovascular conditions. This may include tests such as an EKG or stress test, blood tests, and an electrocardiogram. A patient's medical history and characteristics may not always reliably distinguish between cardiac and oesophageal causes of chest pain, but they can provide valuable context for diagnosis.
Some key differences between cardiac and noncardiac chest pain include:
- Body position: Reflux-related chest pain may be alleviated by changing body position, such as sitting or standing up straight, while cardiac chest pain persists regardless of body position.
- Intensity: The intensity of cardiac pain stays the same when breathing deeply, while GERD may cause temporary, severe chest pain when taking a deep breath or coughing.
- Duration: Noncardiac chest pain may last from a few seconds to a few hours, while cardiac chest pain associated with a heart attack may be persistent.
- Radiation: Cardiac chest pain is more likely to spread to other parts of the body, such as the left arm or jaw, while NCCP may be more localized.
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GERD treatment options
GERD, or gastroesophageal reflux disease, is a chronic condition that people often live with for the rest of their lives. It is characterised by acid reflux, where gastric acid escapes from the stomach and backwashes into the oesophagus, causing a burning sensation. GERD is a common cause of noncardiac chest pain, which is chronic pain that resembles cardiac chest pain (angina) but is not heart-related.
Treatment options for GERD include:
Lifestyle and Dietary Changes
Lifestyle changes are often the first course of action for treating GERD. This includes losing weight, changing your diet (e.g., avoiding highly acidic, fatty, spicy, fried, and citrus foods, as well as chocolate, peppermint, coffee, and alcohol), avoiding large meals, quitting smoking, not lying down immediately after a meal, and elevating your head when lying down.
Medication
Over-the-counter antacids (such as Tums, Alka-Seltzer, and Gaviscon) are often recommended to relieve heartburn and diminish common GERD symptoms. However, it is important to take antacids in moderation, as frequent use can increase acid reflux. H2 blockers (e.g., Pepcid, Tagamet, Zantac) are typically used to relieve evening heartburn and lower acid secretion. Proton pump inhibitors (PPIs), such as Prilosec, Prevacid, and Protonix, are the strongest medication for reducing stomach acids and are effective for treating GERD and esophagitis. While PPIs can be obtained over the counter, stronger prescription versions are also available. It is important to note that long-term or overuse of medications can cause side effects and inhibit the absorption of important minerals.
Surgery
While surgery is typically considered when less invasive treatments fail to bring relief, it is the only curative treatment for GERD. Minimally invasive surgical options include the LINX procedure, transoral incisionless fundoplication (TIF), and robotic hernia repair. Anti-reflux surgery can effectively treat gastroesophageal reflux disease by repairing the damaged valve between the oesophagus and stomach.
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GERD symptoms
GERD, or gastroesophageal reflux disease, is a common cause of non-cardiac chest pain. It is characterised by frequent heartburn, a painful, burning feeling in the middle of the chest, behind the breastbone. This occurs when acid from the stomach backs up into the oesophagus, causing irritation and inflammation.
Other symptoms of GERD include regurgitation, where stomach contents come back up through the oesophagus and into the throat or mouth, leading to a sour or bitter taste. Some people may also experience a chronic cough, and pain when taking a deep breath or coughing. This chest pain is often described as a burning or sharp sensation, and it may be accompanied by a sore throat and difficulty swallowing.
In addition to these symptoms, GERD can cause more serious complications such as oesophageal spasms, which can lead to severe chest pain. This pain may be temporary but could indicate something more serious, especially if it is accompanied by other symptoms such as unexplained weight loss, bloody or dark stools, or a feeling of acid refluxed into the windpipe causing shortness of breath.
If you are experiencing any of these symptoms, it is important to consult a doctor. They may recommend over-the-counter medications such as proton pump inhibitors or H-2 receptor blockers, which reduce stomach acid production. However, these medications are not a long-term solution, and lifestyle changes such as avoiding trigger foods and losing weight may also be recommended.
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Frequently asked questions
GERD stands for gastroesophageal reflux disease. It is a chronic acid reflux in your oesophagus.
Yes, GERD can cause chest pain. When gastric acid escapes from your stomach and backwashes into your oesophagus, it burns the tissues on the inside, causing pain.
GERD chest pain tends to feel like an intense stabbing or burning sensation just beneath the skin's surface. It is usually located either behind your sternum or just underneath it in an area known as the epigastrium.
GERD chest pain can be treated with proton pump inhibitors (PPIs), a type of medication that reduces the amount of acid in your stomach. Doctors may also recommend cutting out certain types of food that can trigger symptoms, such as fried foods, spicy foods, and citrus fruits.
